Kim Jae Yeol, Kim Hwan Il, Suh Gee Young, Yoon Sang Won, Kim Tae-Yop, Lee Sang Haak, Moon Jae Young, Kwon Jae-Young, Na Sungwon, Ryu Ho Geol, Park Jisook, Koh Younsuck
Department of Internal Medicine, Chung-Ang University College of Medicine, Seoul, Korea.
Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Hallym University Medical Center, Anyang, Korea.
Acute Crit Care. 2019 Feb;34(1):30-37. doi: 10.4266/acc.2018.00318. Epub 2019 Jan 29.
The 2016 Society of Critical Care Medicine (SCCM)/European Society of Intensive Care Medicine (ESICM) task force for Sepsis-3 devised new definitions for sepsis, sepsis with organ dysfunction and septic shock. Although Sepsis-3 was data-driven, evidence-based approach, East Asian descents comprised minor portions of the project population.
We selected Korean participants from the fever and antipyretics in critically ill patients evaluation (FACE) study, a joint study between Korea and Japan. We calculated the concordance rates for sepsis diagnosis between Sepsis-2 and Sepsis-3 criteria and evaluated mortality rates of sepsis, sepsis with organ dysfunction, and septic shock by Sepsis-3 criteria using the selected data.
Korean participants of the FACE study were 913 (383 with sepsis and 530 without sepsis by Sepsis-2 criteria). The concordance rate for sepsis diagnosis between Sepsis-2 and Sepsis-3 criteria was 55.4%. The intensive care unit (ICU) and 28-day mortality rates of sepsis, sepsis with organ dysfunction, and septic shock patients according to Sepsis-3 criteria were 26.2% and 31.0%, 27.5% and 32.5%, and 40.8% and 43.4%, respectively. The quick Sequential Organ Failure Assessment (qSOFA) was inferior not only to SOFA but also to systemic inflammatory response syndrome (SIRS) for predicting ICU and 28-day mortality.
The concordance rates for sepsis diagnosis between Sepsis-2 and Sepsis-3 criteria were low. Mortality rate for septic shock in Koreans was consistent with estimates made by the 2016 SCCM/ESICM task force. SOFA and SIRS were better than qSOFA for predicting ICU and 28-day mortality in Korean ICU patients.
2016年危重病医学会（SCCM）/欧洲重症监护医学学会（ESICM）脓毒症-3特别工作组制定了脓毒症、伴有器官功能障碍的脓毒症和感染性休克的新定义。尽管脓毒症-3采用了数据驱动、循证的方法，但东亚血统人群在项目人群中所占比例较小。
我们从韩国和日本的一项联合研究——危重病患者发热与退烧药评估（FACE）研究中选取了韩国参与者。我们计算了脓毒症-2和脓毒症-3标准之间脓毒症诊断的一致性率，并使用所选数据根据脓毒症-3标准评估了脓毒症、伴有器官功能障碍的脓毒症和感染性休克的死亡率。
FACE研究中的韩国参与者有913名（根据脓毒症-2标准，383名患有脓毒症，530名未患脓毒症）。脓毒症-2和脓毒症-3标准之间脓毒症诊断的一致性率为55.4%。根据脓毒症-3标准，脓毒症、伴有器官功能障碍的脓毒症和感染性休克患者的重症监护病房（ICU）死亡率和28天死亡率分别为26.2%和31.0%、27.5%和32.5%、40.8%和43.4%。快速序贯器官衰竭评估（qSOFA）在预测ICU死亡率和28天死亡率方面不仅不如序贯器官衰竭评估（SOFA），也不如全身炎症反应综合征（SIRS）。
脓毒症-2和脓毒症-3标准之间脓毒症诊断的一致性率较低。韩国感染性休克的死亡率与2016年SCCM/ESICM特别工作组的估计一致。在预测韩国ICU患者的ICU死亡率和28天死亡率方面，SOFA和SIRS比qSOFA更好。
